Abstract
Objectives To investigate the factors associated with rifampicin-resistant tuberculosis among drug resistant tuberculosis patients and to determine the correlation of rifampicin-resistant TB with MDR-TB in a high MDR-TB burden province of china. Methods A retrospective longitudinal analysis on four surveys of anti-TB drug resistance done in 1998, 2003, 2008, and 2013 in Zhejiang province, China. 4289 sputum-smear microscopy positive suspected tuberculosis patients were eligible at 30 investigation points, chosen by stratified random sampling at survey sites from all over the province. Culturing samples in L-J medium and the drug-susceptibility testing for the 4 first-line anti-TB drugs were performed to all patients. Multivariate logistic regression was carried out to determine the factors associated with the rifampicin-resistance in the study population. Results Overall, there were 3832 patients with positive mycobacterial cultures, and 2813 of the isolates (73.4%) were susceptible to all 4 first-line drugs. Analysis of rifampin monoresistant (RMR) TB indicated the prevalence was 1.1% in new cases and 3.4% in previously treated cases. Among the 359 rifampicin resistant TB (RR-TB) cases, 279 (77.7%) were also resistant to isoniazid, indicating MDR-TB. From 1998 to 2013, the proportion of MDR-TB among rifampicin-resistant TB cases varied between 80.0% and 87.5% (P for trend: 0.768) among previously treated cases and varied from 68.6% to 79.5% (P for trend: 0.403) among new cases. Among previously treated patients, those who received treatment for less than 6 months were less likely to have drug resistant TB (OR: 0.40, 95% CI: 0.16–0.97) or MDR-TB (OR: 0.24, 95% CI: 0.07–0.81). Patients who received anti-TB treatment in a general hospital were less likely to develop MDR-TB than those treated in a TB clinic (OR: 0.08, 95% CI: 0.01–0.72). Conclusion This study highlights a high proportion of RMR-TB among new RR-TB cases in Zhejiang, China. The management of treatment with rapid and accurate diagnosis of MDR-TB other than only relying on RIF susceptibility testing is crucial for improving adherence and outcomes in patients with drug-resistant TB.
Highlights
Drug-resistant tuberculosis (TB), including rifampicin (RIF)-resistant TB (RR-TB), multidrug-resistant (MDR) TB, and extensively drug-resistant (XDR) TB are major threats to the control of TB worldwide
Our analysis indicated that 22.7% of new cases (95% confidence interval [confidence intervals (CIs)]: 21.3–24.1%) and 52.7% of previously treated cases were resistant to at least 1 of the first-line drugs (Table 1)
Discussion e increasing incidence of MDR-TB is a major concern for TB control in a high burden country
Summary
Drug-resistant tuberculosis (TB), including rifampicin (RIF)-resistant TB (RR-TB), multidrug-resistant (MDR) TB (with resistance to at least isoniazid and rifampicin), and extensively drug-resistant (XDR) TB (with resistant to rifampin, isoniazid, any fluoroquinolone, and at least one of three injectable second-line drugs) are major threats to the control of TB worldwide. An estimated 3.4% of new TB cases and 18% of previously treated TB cases had MDR/RR-TB in 2018 globally. While in China, 7.1% of new cases and 24% of previously treated cases had MDR-TB, higher than the global averages [1]. Rifampicin and isoniazid are key anti-TB drugs that are used for initial treatment and for the retreatment of TB patients. E availability of rifampin allows successful treatment in cases with organisms resistant to isoniazid, streptomycin, or other agents. When resistance to rifampin occurs in Mycobacterium tuberculosis, more than 90% of cases have been associated with isoniazid resistance [2], which has resulted in the prospects for successful. Patients who were infected by Mycobacterium tuberculosis with rifampicin or isoniazid resistance require more intensive treatment regimens [3]
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